Patient Groups Explain to the Court Why Copay Assistance Ruling Must Be Enforced Now
Patient groups, after successfully challenging the U.S. government’s rule allowing insurers to not count prescription drug copay assistance towards patient cost-sharing, filed a brief yesterday explaining why the government must enforce the Court ruling. Additionally, the HIV+Hepatitis Policy Institute, Diabetes Leadership Council, Diabetes Patient Advocacy Coalition, and three impacted patients filed their own appeal of the U.S. District Court ruling to the U.S. Court of Appeals for the D.C. Circuit.
U.S. government appeals drug copay assistance court ruling
“We can’t comprehend why the Biden administration, which has championed access and affordability of prescription drugs for the American people, would appeal this decision. By siding against patients who depend on prescription drugs and with insurers, they are allowing insurers to ‘double bill’ and extract more money from patients and drug manufacturers by implementing copay accumulators.” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, one of the plaintiffs in the lawsuit. “The court’s decision is very clear: copay assistance for prescription drugs without a generic equivalent must now count for patients.”
Biden administration takes on insurer abuses in prescription drug coverage
“While we are pleased that CMS is taking steps to clamp down on insurers who are abusing the system by covering drugs without including them as part of essential health benefits, we are disappointed they are not directing payers to immediately count copay assistance, at a minimum, for brand name drugs without a generic alternative,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “While we understand that the case was recently decided, it will be important that CMS issue guidance that directs payers to comply now with the Court’s decision and ensure enforcement.”
Court strikes down HHS rule that allowed insurers to not count copay assistance
In a major victory for patients who depend on prescription drugs, Judge John D. Bates of the U.S. District Court for the District of Columbia struck down a Trump administration federal rule that allowed health insurers to not count drug manufacturer copay assistance towards a beneficiary’s out-of-pocket costs. The case was brought against the U.S. Department of Health and Human Services by the HIV+Hepatitis Policy Institute, Diabetes Leadership Council, Diabetes Patient Advocacy Coalition, and three patients who depend on copay assistance and whose insurers implemented “copay accumulator” policies.